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目的探讨联合腹腔干切除的胰体尾癌根治术(DP-CAR)的疗效、安全性及应用价值。方法回顾性分析2010—2014年第二军医大学附属长海医院胰腺外科同一手术组收治的R0切除的126例胰体尾癌病人的临床资料,均无远处转移,其中行DP-CAR 31例,行传统胰体尾癌根治术(DP)95例。结果 DP-CAR组病人T3~T4期比例(85.7%vs.43.9%,P<0.001)和可能切除胰腺癌比例(87.1%vs.5.3%,P<0.001)均明显高于DP组。DP-CAR组手术时间[(134.4±28.6)min vs.(111.8±38.1)min,P=0.004]及术后住院时间[(16.2±11.0)d vs.(8.4±2.7)d,P<0.001]较DP组明显延长。DP-CAR组病人术后C级胰瘘(19.4%vs.2.1%,P=0.003)及术后出血(19.4%vs.3.2%,P=0.007)发生率明显高于DP组,且有2例病人因胰瘘继发腹腔出血死亡。DP-CAR组与DP组病人术后中位生存时间分别为19个月和20个月,两组差异无统计学意义(P=0.652)。结论 DP-CAR可提高可能切除胰体尾癌手术切除率,手术疗效满意,可使部分病人获益,但术后并发症发生率及病死率高于DP,手术风险相对较高。
Objective To investigate the curative effect, safety and application value of combined radical celiotomy (PD-CAR) with radical celiotomy. Methods We retrospectively analyzed the clinical data of 126 patients with R0 resected pancreatic cancer from the same surgery group in Changhai Hospital affiliated to Second Military Medical University from 2010 to 2014. There was no distant metastasis among them. There were 31 cases of DP-CAR, A total of 95 cases of traditional radical pancreatic cancer radical operation (DP). Results The proportion of patients with DP-CAR between T3 and T4 (85.7% vs.43.9%, P <0.001) and patients with resectable pancreatic cancer (87.1% vs.5.3%, P <0.001) were significantly higher than those in DP group. The time of operation in the DP-CAR group [(134.4 ± 28.6) min vs. (111.8 ± 38.1) min, P = 0.004] and postoperative hospital stay [(16.2 ± 11.0) d vs. (8.4 ± 2.7) ] Than the DP group significantly prolonged. The incidence of grade C pancreatitis (19.4% vs.2.1%, P = 0.003) and postoperative bleeding (19.4% vs.3.2%, P = 0.007) in DP-CAR group was significantly higher than that in DP group Cases of patients died of pancreatic fistula secondary to abdominal bleeding. The median postoperative survival time of patients in DP-CAR group and DP group was 19 months and 20 months, respectively. There was no significant difference between the two groups (P = 0.652). Conclusions DP-CAR can improve the resectability of pancreatic body and tail tumor. The satisfactory curative effect can benefit some patients. However, the incidence of postoperative complications and mortality is higher than that of DP, and the operation risk is relatively high.